Some Training Blog

Digg! this story.

PT Week 1

Hopefully I can explain everything clearly without being too wordy! OK, not likely. I also apologize in advance for all the leg photos.

First, let me describe my problem: Beginning in mid-December I had some knee soreness on both sides after running. It was worst when I was holding a mid-squat (90* angle), when standing up or sitting down, or after sitting for a long time. I started doing all kinds of exercises, including most of the ones I will describe here, to correct the issue, but now I find out I have done them incorrectly. The soreness did decrease in intensity, but it would still return after each run particularly on my left. Since untreated knee issues can eventually lead to breakdown of cartilage and osteoarthritis, I decided to take the mild pain seriously before it became something permanent.

Upon evaluation, I was diagnosed with patellofemoral chondromalacia and prescribed physical therapy. There, I learned that I tend to allow my knees to turn inward, and also that I hyperextend. The way I hold myself means that the inner quads and lower glutes aren’t much used and are weakened. Strengthening these muscles by repeated exercises with correct form should lead me to eventually hold myself correctly at all times, therefore hopefully eliminating knee soreness.

In these photos, I have tried to illustrate the issue. The photo on the left is how I generally hold myself. You can see that the kneecap falls inside of the big toe. In the photo on the right, I have rotated my knee so that the kneecap is more in line with the foot.

For every activity that I do now, whether it is using the bike or elliptical at the gym, or standing in line at the grocery store, I am to focus on A) keeping my knee in the correct posture by tightening my glutes and B) not locking my knees. (Look in the mirror, tighten your glutes, and watch what your knees do. Then you will see what I mean!)

I am also to avoid running (for now) and using machines where I stand and work the legs. I was also told to stay away from the seated leg extension machine, as this puts a lot of pressure on the patella and will irritate the condition.

Now, finally, for the exercises. Please keep in mind that these were tailored for me and my issues. There are other exercises that aren’t on my list because I don’t have strength, flexibility, or range of motion problems in those areas, but might be helpful to you. Otherwise, I hope this proves helpful to someone.

Week 1 PT Exercises

Hamstring Stretch: Lie on your back with a towel around your foot. Straighten knee ad bring your leg towards your head until you feel a stretch. Hold for 30 seconds, work up to 5 stretches.

Quad Sets: Form on this is very important! Because I hyperextend, I was told to put a rolled towel under my knee. The knee must be in the correct position, not rotated inward, with the inner quad pointed up. Tighten the quad by pressing the back of your knee down, looking for a visible contraction of the inside top of the quad above the knee (where the arrow is pointing.) Do not lift the heel off the floor while contracting. Hold for 5 seconds, work up to 30 reps per leg.

The picture on the left shows incorrect position during the quad set, while the right shows correct position. Use this same position for the Straight Leg Raises.

Straight Leg Raises: Lie on your back, uninvolved knee bent. Straighten other leg into a quad set, and then slowly raise it until it is even with the other knee. Slowly lower, pausing halfway down, then lower completely. Work up to 30 times per leg.

Hip Adduction: Lie on your side with top leg in front. Slowly lift lower leg off the floor, and then slowly lower. Work up to 30 reps.

Hip Abduction: Lie on your side with bottom knee bent and top knee straight. Slowly lift top leg upwards 12-18 inches without rolling hips forward or backward. Work up to 30 reps.

Glute Lying Leg Raises: Lie on your stomach with knees straight. Lift one leg up, squeezing the glute to accomplish this. Now, I have been doing all sorts of rear leg raises. The difference the PT showed me was to not let the part I am contracting creep up towards my lower back, but instead keep the contraction to just the lower part of the glute near the thigh. This, of course, means a more subtle movement.

Heel Raises: Standing up, slowly raise up onto toes by bringing heels of your feel off the ground. Slowly Lower. Work up to 30 reps. (I like to do a version of this where one foot is resting on a chair so that one leg does all the work.)

Hamstring Curls: Lean against a table to keep front muscles uninvolved. Slowly bend knee, bringing heel towards butt. Slowly lower. Repeat 30 times.

Mini Squats: Stand with feet shoulder width apart, toes pointed straight ahead. Slowly bend knees and hips as if sitting into a chair. (I had this wrong with squats… the butt should go out and the weight onto your heels. I always tried to keep my hips centered over my feet.) You should be able to see your toes as you bend your knees and hips. Work up to 30 reps.

On the left you see the incorrect way to do squats, with the knees inside the big toes. To do these correctly, do not let your knees cross over your big toes, but still keep your toes pointed straight, as shown on the right.

Step Over and Backs: Using a step (or pile of books!) place one foot (foot A), toes forward, on the step. This foot will remain on the step until you switch feet after all reps. Step up, bringing your other foot (foot B) alongside it and pause. Step forward off the step with foot B so it rests on the ground, still keeping foot A on the step. Now reverse the whole action, bringing foot B back up onto the step, and finally back to the starting position. This is one rep. Work up to 30 reps.

Again, it is very important to keep the knee from falling inside of the big toe. Keep the knee centered over the foot for all movements. Picture on the left is wrong, picture on the right is, well, right.

Standing on One Leg: The point of this is to practice correct standing form, and strengthen the muscles that enforce it. You should, again, keep your knee from crossing beyond your big toe. Also, keep the knee slightly bent. Put all your weight on one foot, bending the opposite knee. Do not let your hips dip or tilt to one side, but keep them level and your posture straight. Hold for 10 seconds and repeat 10x per leg. To increase difficulty, close your eyes or stand on a pillow during the exercise.

So there you have it! These are all the exercises prescribed to me for week one of physical therapy. The ones that I have given extra instruction and/or pictures for (ie: where form is the focus) seem to be the most important to me. I can really feel them working muscles I don’t tend to use much, even when I am supposedly working those groups because my natural form leaves them out of the equation.  I’ll be back next week to report what new exercises have been prescribed.

~To good knee health!~